ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Presented by Darren Russell: Associate Professor, Cairns Sexual Health Service

 

Darren mentioned in his report that of the 450 PLHIV attending Cairns Sexual Health service, 13% were Aboriginal and/or TSI. This number though not out of control, presented an issue for concern. In 2014, there was an outbreak in FNQ aka “the Cairns Cluster”. This outbreak was more predominant in the younger male population (18-30) and because these individuals are young and highly mobile, the threat of infection spreading was notable.  Other reasons elevating the risks are social disadvantage propagating poorer health outcomes, increased drug and alcohol use and low health literacy.

The HIV care continuum was used to guide treatment from detection to viral suppression. This care model enabled the team to observe how their Indigenous clients moved in and out of the treatment cascade influenced by personal life circumstances at a given time. This constant shift though multi-factorial, revolves around the social determinants of health such as income, housing, education and family situation. 

With gaps identified, the team came up with means on how to keep clients engaged in their treatment. An invidualised response is essential; support the client with their needs; have the consultation where the clients want it done (even under the tree!); utilise Aboriginal health workers to build trust and provide culturally appropriate care. The team also identified areas for improvement like expanding the multidisciplinary team to involve more members; Increasing contact tracing and linkage and finding novel approaches to make the service more available and appealing to the Indigenous members of the community.

 

 

Julie began her presentation with a slide that outlined food security measures as quantifying the availability of food; the ability to access available food; the ability to utilise available food, and; the stability of accessible and available food sources.

 

In Australia, 1 in 6 people report having experienced food insecurity at least once in the last 12 months (Food Bank, 2016), which aligns with other data pertaining to food insecurity. Thus far, the prevalence of food insecurity amongst people living with HIV is unknown.

 

The rationale for the study is underpinned by literature that links food insecurity to adherence issues. Also, the HIV Futures 6 study showed that 42% of people living with HIV received financial support through government means and that 31% lived below the poverty line.

 

Julie’s study utilised data from participants who utilised service across 6 sites in Sydney. The goal was to have 200 participants of varying age and ethnic backgrounds and with varying CD4 counts and viral loads. Administered through a phone survey, the study involved asking participants questions that were rated using the USDA six item subset tool. 162 participants were surveyed (92% male and 8% female) which ultimately matched the gender balance of the HIV Futures study. Of those surveyed, it was found that 47% were food insecure.

 

All Indigenous respondents surveyed were found to be food insecure. Key factors for food insecurity included being unemployed or living on a pension; inner-city living; a low CD4 count, and; a lower self-perception of health. Employment and education beyond high-school level led to better food security for those surveyed.

 

Julie emphasised that an awareness of food insecurity for people living with HIV may be lacking in the sector and that this is an issue that needs further investigation.

 

Leah Williams walked us through the ways in which her service created small changes to their service that resulted in greater outcomes for vulnerable groups.

The most vulnerable people living with HIV:- those 10% not on treatment or linked into services were identified and then the barriers to them accessing health care were identified , such as the need for a GP referral and the restrictions surrounding Activity Based Funding which means they can be discharged from a service if they do not attend 2 successive appointments. 

Flexible service provision is the key to accessing these hard to reach groups: - drop in clinics and small but important changes such as assistance from administrative assistants/ reception staff when vulnerable changes to attend.

The  take home message was : Tweak your service to meet the needs of vulnerable groups rather than asking those patients to access care that seems inflexible to them. 

Day 2 Morning Session.

Good morning folks, welcome back. The sun is shining, its still a bit cold in Canberra but you wouldn't recognise the place. I started the morning with the Opening plenary for the Sexual Health Conference, some fantastic speakers with valuable insights. Prof. Kit Fairley from Melbourne Sexual Health Centre was a highlight (fantastic speaker) as was Prof. Gracelyn Smallwood speaking on Indigenous HIV and sexual health with her career highlights numerous. Not just an informative session but also very entertaining. Wonderful speakers.

Our last speaker for the morning was Dr Ayden Scheim from the University of California speaking on Trans Rights, sexual health and HIV, referring to the studies, or lack thereof, in regards to Trans people in HIV and Sexual Health research. This as another area where work needs to be done and the way in which we as clinicians or researchers attend this will greatly impact on our ability to be proactive and effective. If I say something from personal and professional experience, work with us, not on us.

I will get off my high horse now and am currently sitting in the next session with Leah Williams, a Nurse Practioner from Perth Hospital speaking on the REACH Programme where maintaining clinical contact with at risk patients more likely to not be presenting.

Normally where referred patients would be discharged from care after two missed appointments, the Immunology clinic sought a change in the structure of clinic visits which is REACH. Candidates were identified as living in metropolitan area, with a detectable viral load and who would avoid or miss clinical appointments.

A cohort of 108 patients was found for the programme, consisting of 65% men, 32% women and 3% people identifying as trans. The research found that the most hard to reach people were Australian and not  born overseas. Interestingly a number of these people were identified as attending the clinic weekly despite no appointments, an indicator that people felt safe to be within this clinical area and with staff. Collaborating with other services, such as Emergency Department presentations by REACH clients being notified to the clinic and staff being able to take the opportunity to engage with the client.

Once i the programme, REACH patients could turn up whenever they like, which was no different to many of their previous attendance. No appointments were made on the books and so no data on "Did Not Attend" was recorded, a huge plus to the clinics KPI's. Focus was on the presenting issues of the patient rather than making visits specifically HIV focused. Another important change was having clinic Administration staff aware of the clients being part of the REACH programme and no reason for a visit was necessary, another way of making clients feel welcome and the clinic appear more accessible.

The "Virtual Clinic" was one innovation of REACH where patient case files were reviewed weekly by a multidisciplinary team and any changes in care or needs were identified in order to facilitate the above changes and give appropriate patient care.Ensuring more support was avaialble to patients commencing new treatments early on and after diagnosis was identified as an effective strategy and client medications were also made available to be picked up from the clinic daily or weekly and use of webster packs to keep things simple and accessible again were effective changes.

In total, DNA rates were halved, patients were happy and were no longer discharged by the service and quality care was given to the patients. The take home message was that we make small tweaks ourselves to make things work becuase patients less likely to do so. Hahaha, so true.

Thanks for following me and looking forward to the second part of the day.

 

 

Please join us for a memorial event celebrating the life of one of Australia’s leading HIV advocates, Levinia Crook… https://t.co/N7dof5xaGa

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